Paramedic Response Unit/Rapid Response Vehicles/Fly Cars

[snowbank]

Hi,

I am doing a research project on Paramedic Response Units.

Does anyone know of any place(s) that are currently using them? If so, is there a web site for them? Is there any place(s) that tried them but are not using them now...if so why?

How are they utilizing (Deploying) the Paramedic Response Unit... is it just a clock stopper for AMPD (Advanced Medical Priority Dispatch) call determinates "D" & "E" (Life threatening..."Category A" calls for the UK people on the site) or are they being used for less acute calls such as the obvious death (9-, diabetics that will probably cancel EMS upon awaking...or are they being used in rural areas for all calls/ outskirts of urban centres?

What is the level of care that are staffing these units?...EMT-P? RN? EMT? PCP, ACP, CCP, EMR?

Are they staffed with 1 or 2 persons?

Do they ever transport patients?

Thank you in advance for your time.

Snowbank

[Just Plain Ruff]

shoot me a pm, I have a service who uses them in my area. I still have some contacts at that service. I also used to work at that service so I can probably help you out.

[FormerEMSLT297]

NYC-EMS (pre-merger) used them fairly extensively in the late 1980's- early 90's and they had mixed results for the following reason/s:

At the station I worked at the ran 3 medic units ..... 2 24 hours and 1 16 hours in addition to multiple BLS units.

The medic units were originally transport units Radio designations 13X, 13V, 10Z (V-Z designate ALS transportt units)

Then came the vehicle shortages,,, so they gave the Ambluances to BLS units, and put the medics in fly cars.

13X became 12U (U being ALS non-transport)

13V became 13U

10Z became 10U

So what that basically did was that you just REMOVED 3 transport units from your system.

It was good and bad, because Medics were going on priority jobs, but if the pt was BLS they could clear and stay in service, that was the good part.

The bad part was that a lot of calls were mis dispatched as high priority calls,, Unconcsious, Cardiac and Difficulty Breathing. So if no BLS unit was available the medics went alone and when they got there, they were stuck waiting for a transport.

And when call volume got really bad, the disp. would send the medics on injury calls, just to clear the disp. screen.

I know of several instances where the medics were tied up at scenes with broken legs and arms, for 1 even 2 hours before a transport became available, now that was extreme, but it did happen.

I also know that in some places like southern MD, NJ, and Long Island NY, it works well. If you plan to implement it, you need to make sure there are enough transport units so that the medics don't get stranded.

NYC-EMS, now FDNY-EMS, is planning to revamp the PRU system and allow supervisors to provide ALS with a BLS partner. The problem in NYC is still that Medics get misdispatched to calls where they are not needed, and sometimes, medics are not available for the patients that truely need them.

As far as types of vehicles ,,, I like www.odyessyauto.com or www.plcustom.com for the vehicles like tahoes or suburbans.

[Medic2588]

In NJ, projects for the most part utilize these fly cars for paramedic units. They are usually SUVs or utility body vehicles that do not transport. They are staffed with 2 paramedics. We intercept with the BLS and provide care in their ambulance en route to the hospital. As a paramedic I love it. Occasionally it can be a redundent use of manpower, but that is how the protocols in our area are set up.

Other systems in NJ utilize ambulances for their paramedics. These often do not transport unless there is no BLS ambulance available. The usually a culture thing (ALS/BLS tuff wars).

Devin

[Niftymedi911]

I'm in the same boat, our agency is nothing but ALS, but now that we have the AMPD-Pro Q/A service I'm trying to get Admin to take a look at the QRV response model. 1 QRV for every 2 units we have in the field. So total of 15 QRV's throughout the county that can handle the lower priority calls which in turn leaves the ALS transport units available for Echo, Delta, and Charlie responses. The QRV's (ALS) would be utilized for all calls, but if its an Aplha or Bravo response, send the QRV and they can decide if transport is warrented. We're nearing 80,000 calls per yr with 32 units now. It's time our dinosaur response dies.

[strippel]

Back in the day (=when EMS was fun) our system was hospital based chase truck ALS (2 medics, maybe a nurse), and community BLS transporting ambulance, with 2 or more EMTs on board.

Call volumes drastically increased. ALS would have to wait for BLS. BLS would have to wait for ALS. To solve the problem, the hospital ALS services got ambulances. When the BLS didn't show, they could transport.

About 10 years ago, call volume increased more, volunteers disappeared, interfacility transport coverage was lacking. Also, non-transporting ALS units do not receive a large portion of Medicare income.

Three of our local hospitals consolidated their ALS services, and 3 BLS services joined in. These were the services that covered the city, and populous suburbs. No more ALS chase.

Since we are overseen by the hospitals, all expenses need to be justified. An ALS ambulance (Medic and EMIT) are far more cost effective than 2 vehicles and from 3 to 7 providers. We now (usually) have enough units to cover our area, and handle the discharges and interfacility transports from the hospitals. Insurance billing and revenue are up. We now do about 28000 911 calls and transports

We still do "chase", but now an ALS ambulance responds to assist a rural BLS unit. If the county is busy, or if the call is the BLS 2nd call their district (and they fail to respond), there is a transporting ambulance on scene to take the patient. Only the supervisor and management staff have a "chase" vehicle, Excursion or Tahoe. We also have 2 BLS QRS (quick response) vehicles. One is staioned in the country, and staffed by volunteers. The other is the fleet service vehicle, and our maintanance officer will back up ambulances when needed.

There are 2 services in our area that provide "chase truck". One is hospital based (the 4th hospital), and the other is community based ALS chase. They both have billing agreements in place with their BLS services, so they can share the Medicare money.

[Eng542ine]

ALS Intercept vehicles are one of those concepts that looks GREAT on paper but, TOTALLY SUCK in reality!!!

Granted I've been a medic a whopping month now... I have had AMPLE opportunity to form this opinion and cite three instances off the top of my head where the wait for a transport unit seriously compromised patient care...

1) CVA... after BLS took the better part of an hour to grace us with their presence and the transport time to the Stroke Center he was out of the 3 hour window

2) Status Ep... 20 minute wait for BLS... that was 15 minutes after we completed the RSI...

3) Rapid A-fib... non-responsive to diltiazem (or any other damn thing we tried)... we had plenty of time to play in the FIFTY minute wait for a BLS ambulance that ended up coming from 7 towns away... in the next county!!

Every unit ALS and BLS should have transport capability. There's no feeling I have ever experienced that can compare with the absolute helplessness that comes with having to wait almost an hour on a scene with a critical or unstable patient and have no way to get them to definitive care...

WELL... except when you hear an ALS job go out somewhere (with no other unit available) and you're on a scene waiting for BLS to arrive so you can release an INFINITELY stable patient to them...

First and foremost this falls on the State of New Jersey for failing to require municipalities to provide EMS. This is what happens when you let the people at the helm of the failing volunteer system dictate policy... fools...

[CBEMT]

ALS Intercept vehicles are one of those concepts that looks GREAT on paper but, TOTALLY SUCK in reality!!!

Don't blame the system model for New Jersey's failure to execute it.

[kristo]

In Reykjavik, Iceland, there's something of the kind that (I think) you're looking for.

So, basically, they have six ambulance/fire stations spread around the city. In each, two staffed ambulances with a minimum of one EMT-B and one EMT-I (since all employees are required to get their EMT-I after 36 months as EMT-B's, they're mostly EMT-I's). They also have an increasing amount of paramedics.

In one of these stations, another ambulance, so called "emergency truck" is stationed, which is staffed by two ALS providers (usually two paramedics, but sometimes EMT-I's, I believe) plus a doctor who has received some out-of-hospital training, provided by the ER. This ambulance is equipped just like the other ones, except a few more meds and a heatbox for newborns.

Now, the way things work there, for all calls that are potentially cardiac, respitory distress, very young children, severe trauma, etc, they dispatch one or more ambulances from the nearest stations (sometimes from two directions to get them there sooner) plus the "emergency truck" from the main station.

The "emergency truck" almost never transports. Sometimes the doctor rides with the other ambulance to the hospital, if needed, but they try to have him/her free for other calls that might come up, also the doctor carries a cell phone and acts as online medical command, which is able to come to the scene if needed. So they will sometimes travel from one scene to another, if there's more need somewhere else.

The EMD's will usually err on the side of caution, if the "emergency truck" is not busy, they will send them if they think they might be needed. If there's a student ride-along (which there usually is), it's usually on that one, as that one is guaranteed to get all the "student-friendly" stuff. That'll be medical students, nursing students, EMT-B/I students (don't have EMT-P training in Iceland yet) or EMT's from rural parts of the country, with low call volume, they often come to Reykjavik a couple of times a year to brush up on their skills.

[mediccjh]

ALS Intercept vehicles are one of those concepts that looks GREAT on paper but, TOTALLY SUCK in reality!!!

It sucks because the volleys can't/won't get out during the day for grandma having the CVA, but if an MVA w/ entrapment come in, they come out of the woodwork.

It's that simple.